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Lack of Medical Necessity

Unnecessary care provided to patients — whether in hospitals, in skilled nursing facilities, through hospice programs or in other settings — not only defrauds Medicare and Medicaid, it also can seriously harm patients.

Whistleblowers have been responsible for stopping many instances of unnecessary care. One of the most high-profile cases involved hundreds of hospitals that implanted electronic heart devices allegedly before a waiting period required by Medicare to see if the heart could recover from a heart attack or bypass surgery on its own.

More than 500 hospitals in 43 states paid over $280 million to settle the whistleblower case. Two of the lead government prosecutors in the case from the US Attorney’s Office in Miami and from the US Department of Justice have since joined Phillips & Cohen to represent whistleblowers.

If you would like to discuss your concerns about medically unnecessary care by a particular healthcare provider and find out what your options are, contact us for a free and confidential consultation.

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